<div align="center"><span id="msg"></span></div>
<form method="post" action="">
<table class="registration" border=1><tr>
<th><b>&nbsp;{TITLE}</b></font></th>
<th><b></b></th></tr>

<tr>
<td height="36"><div align="right">{BAD_WORD}<br /></td><td>&nbsp; <input type="radio" name="bad_word" {BWYES} value="1" /> Yes
<input type="radio" name="bad_word" {BWNO} value="0" /> No </td></tr>

<tr>
<td VALIGN="top" height="36"><div align="right"><b>{CENSORED}</b></td><td><textarea style="width: 312px" value="{WORDS}" type="text" name="words" />{WORDS}</textarea></td></tr>

</table>	

        <div align="center"><td height="36"><input type="submit" class="inputButton" value="{CONFIRM}" />
 	    </tr></td></div></table></form>